Kimberly Marie Kilian, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

018586 Issued in NY

Practice address

60 W Big Beaver Rd Ste 100
Bloomfield Hills, MI 48304-3913

Phone

(248) 258-5100

Fax

(248) 258-5110

NPI assigned

Mar 27, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Kimberly Marie Wisniewski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kkilian1134678@direct.hfhs.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1265826275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17799 BAYSIDE DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480421173",
            "telephone_number": "810-656-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 W BIG BEAVER RD STE 100",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483043913",
            "telephone_number": "248-258-5100",
            "fax_number": "248-258-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILIAN",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-27",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007307",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WISNIEWSKI",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Fuad Khazneh-Katbi, M.D.
• Kheir Alzouhayli, MD
• Hanna Michel Khouri, M.D
• Majd Khytaz, AGAC-NP
• Ellen Jean Kiefer, OTR
• Ghassan Killu, PHARMD
• Azra A Kim, MSW
• Kingswood Internal Medicine
• Kingswood Urgent Medical Center PC
• Kirsch and Blau DDS

• Physician Assistant in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.